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PaperclipPerfector  8d ago (text post)   1030 thread views

Wellness Wednesday for May 6, 2026

The Wednesday Wellness threads are meant to encourage users to ask for and provide advice and motivation to improve their lives. It isn't intended as a 'containment thread' and any content which could go here could instead be posted in its own thread. You could post:

  • Requests for advice and / or encouragement. On basically any topic and for any scale of problem.

  • Updates to let us know how you are doing. This provides valuable feedback on past advice / encouragement and will hopefully make people feel a little more motivated to follow through. If you want to be reminded to post your update, see the post titled 'update reminders', below.

  • Advice. This can be in response to a request for advice or just something that you think could be generally useful for many people here.

  • Encouragement. Probably best directed at specific users, but if you feel like just encouraging people in general I don't think anyone is going to object. I don't think I really need to say this, but just to be clear; encouragement should have a generally positive tone and not shame people (if people feel that shame might be an effective tool for motivating people, please discuss this so we can form a group consensus on how to use it rather than just trying it).

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The disc issue with deadlifts is really common and usually comes down to bracing not being tight enough at the start of the pull or losing tension as fatigue sets in. At 1.84x bodyweight even a small form breakdown under fatigue will catch up with you eventually. Beyond core work it might be worth trying a belt just for working sets. Not as a crutch but it gives you much better feedback on when your brace actually breaks. A lot of people find their form cleans up once they can feel that happening in real time. Also worth having a trainer watch one set. Sometimes the issue is something small that you just can't see yourself.

I assume you meant to reply to me. Thanks for the suggestions, I do want to ask someone in the gym to check my form. On Saturday I went back to using my belt (having not used it for the past few weeks) and didn't experience any issues on the day or the day after.

What's the general rule for going to the doctor for a shoulder injury vs waiting to see it it'll heal? Are there any "shut up and go to the doctor" signs? I deal with so much chronic pain that I'm not sure what a reasonable person would do in my shoes.

Bro science answer:

-- Do I know how I hurt it? If the answer is yes (Dave cranked on that armbar/I shouldn't have gone for that deadlift), then I'm more likely to know how it will recover

-- Is it getting better over time or worse?

-- Is it getting in the way of day to day life significantly?

If the answers to those questions are bad, then going to seek treatment is a good idea.

I think usually, “if it still hurts in a couple of days, or if you can’t move it properly (not because it’s stiff)”.

Maybe try going to a physio before going to a doctor? Doctor will probably just tell you to go to a physio anyway.

That's a good idea. Thanks.

Check your state laws - doctor cartels have made it illegal to access PTs indefinitely without a doctor's stamp of approval in many states.

As per your link the restrictions include things like:

"A therapist who has more than one year of experience supervises any therapists licensed for less than one year."

And:

"The therapist thinks the care is within his or her scope. If a therapist thinks the care is outside of his or her scope, he or she must refer the patient to an appropriate healthcare provider."

How are these unreasonable?

Insurance is more likely to prove a barrier.

I knew I'd summon you with this comment. You've quite simply cherry picked some reasonable sounding lines and neglected to mention the other conditions.

For example:

"A therapist who has more than one year of experience supervises any therapists licensed for less than one year."

Wow, very reasonable, thank you AMA. That's Minnesota. What other restrictions do they have?

Therapy does not continue beyond 90 days without a referral.

So I stand by what I said - in many states it is illegal to see a PT indefinitely without seeing a doctor.

So I stand by what I said - in many states it is illegal to see a PT indefinitely without seeing a doctor.

That's extremely different from what you said before - seeing a PT for initial evaluation and treatment is not the same as seeing a PT indefinitely without further evaluation (such as things like imaging).

One of the purposes of that sort of restriction is to prevent scams where a PT just bills insurance without doing anything.

One of the reasons I can be reliably summoned this way is because the complaint is essentially baseless slander that does not acknowledge the possibility of other sensible explanations or the reality that the situation has changed in healthcare has changed. I am therefore (reasonably I think?) frustrated.

Conspiratorial posts about the AMA have low predictive value and create uncertainty for legitimately information seeking third parties like OP.

That's extremely different from what you said before

Really? Let's double check.

doctor cartels have made it illegal to access PTs indefinitely without a doctor's stamp of approval in many states.

in many states it is illegal to see a PT indefinitely without seeing a doctor.

Are these the same claim? Have I changed my position? Let's get this straight before I respond to your other points.

Weird, could have sworn I double checked and didn't see anything about the timelessness in your original post. shrug

That doesn't address the substance of my complaint, however.

More comments

Yup. If it's an old injury, and there are no glaringly obvious signs of ongoing inflammation/disease, physio would be the first port of call. I imagine it's easier to go to a physio and then a doctor if they so advise, instead of the other way around.

Yes this is always my plan - straight to PT. Obviously I have more information which makes things a bit easier for me.

In the U.S. you do need to ensure your insurance will allow this, but a local PT can usually help walk you through that.

So I'm studying for the MRCPsych again, and the standard resource everyone uses for this is called SPMM. SPMM costs money. If you pay extra money, you get mocks. If you feel desperate, you can pay even more money, for a "stats crash course,".

The MRCPsych Paper B is heavy on statistics. Most of my colleagues find this difficult because most of my colleagues went to medical school, where the stats curriculum is approximately "p < 0.05 means good." I find it less difficult, which is not the same thing as enjoyable.

The problem is that SPMM's stats teaching is bad. I read a passage, frown, screenshot it, send it to ChatGPT or Claude, and ChatGPT says "yeah, this is wrong." This has happened enough times that it has stopped being surprising and started being a sort of recurring bit. The remaining percentage of the time, the notes are oversimplified to a degree that would make an actual statistician put their head in their hands, which I'll grudgingly accept as the cost of doing exam prep.

Now, I present the question that broke me today.

There's a study, presumably real, looking at childhood trauma and hallucinations in adulthood. There's a graph. The y-axis is the probability that someone has childhood trauma somewhere in their history. The x-axis is "number of hallucinatory modalities," running from 0 through 5, because apparently the authors decided five was enough senses and shipped it. Sure, I guess we can skip proprioception, vestibular positioning, and the other minor crap.

The question: "The predictor that emerged as the statistically significant variable is most likely to be..."

I pick ratio variable.

Let's examine my reasoning. The variable is a count. Counts have a true zero, where zero modalities is a meaningful and non-arbitrary absence rather than an arbitrary point on some scale. The intervals between values are equal: going from 1 to 2 modalities is the same conceptual distance as going from 3 to 4. And the ratios mean things, in that a patient hallucinating across four modalities is doing so across literally twice as many modalities as someone hallucinating across two. This is the textbook definition of a ratio variable. Stevens 1946. Every introductory stats book ever written.

SPMM informs me that the correct answer is "ordinal." I wanted to die.

I tried to be charitable. Maybe SPMM is operating from some idiosyncratic but defensible framework I'm not seeing. Maybe there's a niche position that count variables with low cardinality should be treated as ordinal because of how they behave in small-sample inference. Maybe somebody, somewhere, has a real argument.

I went to ChatGPT and laid out my case. ChatGPT said my logic was textbook, my answer was correct, and SPMM was wrong, but I should still pick whatever SPMM said in the actual exam because the exam doesn't care about being right, it cares about agreeing with whoever wrote the answer key. This is very sound career advice and also makes me want to lie down on the floor.

I pushed back. I said no, I have standards, I want to know whether there is some technical sense in which SPMM could be right and I am wrong. ChatGPT politely declined to manufacture one. After some pushing, it concedes, and says that I should go with my original answer if this specific question comes up in the actual exam. I screamed internally, because screaming externally would wake my neighbours.

The really insulting part is the upsell.

SPMM, having taught me statistics with the precision and care of a man hammering a nail with a banana, also offers a paid crash course in statistics. I will let you guess how I feel about paying them additional money to clear up confusions they themselves introduced.

There are two hypotheses.

Hypothesis A: SPMM is teaching stats badly on purpose, so that you have to buy the crash course to fix what they broke. This is the version I want to be true, because at least it would mean someone, somewhere, is in charge.

Hypothesis B: at some point, an underpaid registrar was handed a brief that said "write 500 stats questions, here's £500, you have a weekend". They paid peanuts, and the monkey just offered me a banana.

Hypothesis B is overwhelmingly more likely. It is also worse, because at least under Hypothesis A there's a coherent villain. Under Hypothesis B there's just a pipeline of tired people producing slightly wrong content for other tired people, who then sit in their flats at midnight wondering whether they're losing their minds or whether the material is in fact wrong, and there is no one to be angry at, because everyone in the chain was doing their best with too little time and not enough money, and the result is diffuse ambient wrongness that lives in PDFs forever, gaslighting trainees into doubting whether ratios still mean what they used to mean.

Anyway. Number of hallucinatory modalities is a ratio variable. It will continue to be a ratio variable on the day of the exam, and if it doesn't, the number of homicide victims in a future study will remain a ratio variable.

Edit:

The study is "Association between childhood trauma and multimodal early-onset hallucinations" in the BJPsych. The authors ran a hierarchical binomial logistic regression with childhood trauma as the binary outcome and number of hallucinatory modalities as a numeric predictor, reporting OR = 2.24 (95% CI 1.16 to 4.33) per additional modality. You can't meaningfully report a per-unit OR for an ordinal predictor. Reporting that OR is exactly what you do for a count variable on a ratio scale. The original authors treated it as ratio. SPMM has marked me wrong for agreeing with the people who wrote the study.

My usual recommendation for this kind of thing is to look for stuff you can pirate that US grads are using. Most US speciality boards have at least on killer app or test prep book. Easy to nab on Libgen or whatever.

Obviously might end up with different areas of focus but overall should get the job done?

LibGen has been down for awhile now, and Anna’s Archive got taken down by the powers to be.

Anna's Archive is still up at the .gl domain.

Welib.org is another good alternative but last time I looked it required registration before you can download.

When using LG make sure you are using the latest TLD - it's still up as of this posting.

Hmm. Not bad advice in a vacuum, but I'd say it's somewhat impractical. The reason I'm using SPMM is because I don't have the time to go through the official reading list cover to cover, or even to skim it properly. American psychiatry textbooks might be of a higher quality, as might be the case for PG-exam oriented material, but the MRCPsych is very UK specific, in terms of knowledge about systems as well as our psychiatric guidance and patient-pool.

Just the stats? Sure. But I have 10 days and no time to do more than cry, or more productively, cry while doing mocks. Maybe if I fail this go, which I really hope won't happen.

Don't they give you dx and med questions???

Of course. But that's only like half the nominal weighting on the test. Maybe 2/3rds. I imagine there's enormous overlap there, but that's one area where the SPMM notes haven't failed me nearly as badly. It's harder to bungle copy-pasting NICE/BAP guidelines.

Not that I would really have the time either way.

godspeed my guy

Thanks! I'm comparing myself to the other trainees when it comes to test scores and I think I'm slightly ahead on net. Not by the margin where I can take my foot off the gas, but I think I have an honest shot. If not, I'll be mad about breaking a lifelong streak of never failing any exam (of actual importance), but that's not the end of the world.

How much does it matter? I mean, obviously it matters for passing the exam, but how much a practicing psychiatrist encounters a situation where they need to know statistics on this level and properly set up variables, unless they do academic research? Or, putting it in another way, if I learned psychiatrists are being taught and examined on wrong statistics, how scared should I be?

Not at all. You can spend your entire career as a psychiatrist without ever having to worry about whether you need to use ANOVA instead of MANOVA. I dare say most psychiatrists don't need to know any of this, I've never seen a senior of mine sit down and calculate PPVs or positive LRs while working with a real clinical case. If they ever knew, they've probably forgotten, and it doesn't seem to hurt them.

In theory, this information might come in handy if we need to do critical appraisals of a new paper or engage in research. That's the theory anyway, the practical aspects of it were already iffy, and these days? Everyone is going to check ChatGPT. There are zero clinical scenarios involving a real patient where this specific question matters.

Or, putting it in another way, if I learned psychiatrists are being taught and examined on wrong statistics, how scared should I be?

Don't lose sleep over it. That's my job. I'd rather be unemployed.

When ChatGPT says the SPMM is wrong, does it provide sources or a mathematical proof?

Yes. It's even something I order it to do in my user prompt, though it's pretty good about doing it my default.

I tell people to always ask for citations or double check the work when doing anything mission-critical with LLMs, and my professional trajectory counts. I usually ask both ChatGPT and Claude at the same time, to reduce the risk of error/hallucination being correlated, and if they disagree, I dig into it (assuming I haven't reviewed their sources and confirmed things to my own satisfaction). Of course, for less important topics, I don't go that far.

Here, SPMM is remarkably wrong. They're so wrong that they disagree with the original authors of the paper they've used for the question. In fact, every single fucking time I've asked, it's SPMM that's wrong and the LLMs correct (when they do disagree, my bullshit detector isn't perfect either).

Last week, I bought fried chicken from an M&S nestled inside my hospital, before heating it in a microwave and then joining the other doctors for lunch. Thought it was pretty solid, and this week, I nipped in to see if I could get another helping.

I found the same dish, read the label more closely and was... less than happy to discover that it said "cook before consumption" on the front, alongside "guidance for handling raw meat". The rear only confirmed my mounting horror. I dare say I felt outright queasy. Oh well, ignorance was bliss, and it's been long enough that if I was going to get salmonella, I'd know by now. I'd rather be a victim of deceptive advertising than food poisoning.

("Southern Fried Chicken", and you expect me to think it hasn't been fried already? Fuck.)

You should be able to tell the difference between raw and fried chicken. Raw chicken in dark meat is stringy and unchewable. You can just go to any grocery and buy a chicken thigh or drumstick and just feel it with your fingers. Cooking softens dark meat chicken considerably. In fact, while chicken is safe at 165F, cooking dark meat to 185F is preferable to make it softer.

Breast meat is a different story. Breast meat is not that stringy even when raw, it could be possibly hard to tell if you got very high quality, fresh chicken breasts and added strong seasoning. Cooking breast meat toughens it up a lot past a certain point. If you normally enjoy tender chicken breasts, it they were slightly raw you might just think they were especially tender. I prefer sous viding chicken breasts to a barely safe temp to get that raw-like tender juiciness and moisture.

Not sure how the labeling differs in other countries but in the U.S. plenty of frozen food still says you need to cook it to 165F for safety even though it's definitely not raw. I feel like it's more likely that it's an ass-covering situation than that the fried chicken was raw. Like, the breading wouldn't even be proper breading if it hadn't been cooked. It would taste and look like raw flour paste.

If it didn't look raw when you ate it, it must've been cooked by the microwaves.

It's a bit late to be praying that that's the case, but I'm not going to risk it again.

Can you eat raw chicken without noticing it? My experience with my own culinary experiments shows undercooked chicken has completely different taste and texture than a properly cooked one. Not sure about the pathogen risks but if you didn't notice I suspect it was not raw.

I'm not sure, it didn't taste raw at the time, though I can't that I've eaten raw chicken on purpose to take notes. I threw it in a microwave at maximum heat for 3 minutes before consumption, it came out hot, and didn't taste awful. That's the main reason I even came back looking for it.

I didn't taste raw chicken, but I tasted undercooked one (I did it to myself, have to admit) and it was rubbery and unpleasant. Generally it's not good idea at all to eat something like that, of course, but nothing bad happened to me, even though I started to check it more thoroughly on rare occasions I cook chicken (usually my wife does it and she knows how to do it right).

Apparently you can cook a single chicken breast in the microwave on high in 4-5 minutes so it might not have been that undercooked.

Threw out my back last week. The squat racks were all occupied, so instead of doing RDLs I did some back extensions on the Roman chair. I have no idea what I did wrong, I held just a single plate and the following evening my lower back seized up and I spent the next few days unable to sit down or bend over without pain.

I like the idea of working out; i fear the possibility of an injury and never having it recover and being in chronic pain

My flatmate injured his rotator cuff. Since I'm also getting old and frail, I made an effort to learn from some-else's experience. I bought some dumb-bells intending to do a variety of arm exercises to strengthen the stupid little muscles that hold the ball in the socket before anything bad happened. I took it steady, starting with just the two kilogram bar, only adding a one kilogram plate when I could do twelve repetitions with just the bar.

I followed the instructions in the booklet that came with the dumb-bell. Start at seven reps. Work up to twelve. Return to seven but with a slightly heavier weight. As I increased the weights, I noticed that I needed to brace my core; I was exercising a lot of muscles, not just my arms.

My back grew stronger and stopped aching. I found that to be a memorably excellent result, worth passing on in a comment in theMotte :-)

Lifting is one of the safest ways to be active

A 2024 review by Tung et al examined 17 studies on injury rates in both powerlifting and Olympic weightlifting and found that powerlifting has an injury rate of just 1 to 4.4 injuries per 1,000 hours of training, significantly lower than popular sports like soccer (around 15 injuries per 1,000 hours). Even more importantly, most injuries reported were minor injuries like muscle strains, overuse issues, joint sprains, etc.

Bodybuilding is even safer [citation needed since I can't be bothered but you can look it up].

Most of the advice I've seen suggests that injuries like this are a lot more common if you're really pushing limits. The advice I see on sport-specific fora (lifting for other sport fitness, not lifting qua lifting) is to avoid small maximal sets, and that 1RM measurement isn't worth the injury risk.

Strength training is good, but it can be good enough much better than sitting on the couch without hitting an exertion requiring grunting or even breaking (much of) a sweat.

Sorry to hear my man. Backs can be finicky. Hope it feels better soon.

It's better already. I first did something to my back back in 2020 in a Covid-induced coughing fit. Took a lot of time to fix it until I found a good neurologist with a YouTube channel. His main message was, "if you break your arm, do you immediately start trying to bend it again to make it less resistant to fractures? Of course not? So why do you think you should treat your back pain by constant stretches and twists and stuff? Leave it the fuck alone, let it heal! Go fix everything else around it! Fix your thoracic spine, fix your glute activation, fix your anterior chain!"

I did all that and realized that deadlifts and RDLs don't actually hurt my back. Can't say that about the girl that was doing deadlifts like a shitting dog, with her PT watching her like it was normal.

  1. Work. Job interview went well, although I'm not sure the start date is going to line up how I hope. Otherwise, wrapping up the resubmission for second first author paper (some drama there), and plugging away on my final paper.
  2. Fitness: Started running again, and going to start Norwegian singles/doubles next week.
  3. Intellectual Stuff: Plugging away at After Virtue. Discussed the Pacific War trilogy with my friend Dylan last night which was also very fruitful. Meditating consistently at least once a day now.
  4. Finances: Third roommate is still not locked down. Spending last month was only 2.6k, which led me to have an almost 30% savings rate!
  5. Dating. Nothing to report.
  6. Tarot. No session this week
  7. Socializing: Spanish happy hour and watching the Kinetic Sculpture race
  8. Screen time: 1 hour phone! Now do my PC haha.
  9. Mental health: feeling excited

How goes it @FtttG, @self_made_human @bird_crombie @falling-star @Tollund_Man4 ?

Doing ok on my stated goals of quitting nicotine, reducing alcohol consumption and gaming, but probably more importantly I'm spending all day at work speaking French which will improve my life a lot more than anything else. Half the point of trying to get more disciplined was so I could improve my French, the other half of getting back into the gym and reading more will come easily enough I think. My girlfriend will also be moving in with me in a month or two and she's not a big drinker so I'll just naturally be better on that front.

I still think it's good to try and waste less time and be healthier but I think I'm on the path I wanted to be on without needing to be super disciplined like I thought I'd have to be. New Year's Resolutions accomplished I guess.

Back home from the accelerator in SF. Still partially burnt out but recovering. Weighed myself when I got home, only regressed 153 lbs -> 148, not as bad as I expected. Trying to put the weight back on with heavy use of fruit smoothies and protein powder, eating mad bowls of pork and rice.

Work demands haven't really relaxed. Early success means we have patients (generating operational tasks), but not money to actually hire more staff. So I've become an insurance biller on top of a fullstack engineer. Been telling myself I want unreasonable things so I'll have to work unreasonably hard to get them. It's hard though, pushing all the time and not having time to recover or experience normal life.

I had a girl that was at least receptive to me that I was really into. We never got to meet a second time 'cause I went to SF right after we met. I missed a chance to run into her at a rave recently because I was working. I got her on instagram and I get the live reminders in my feed that she's still around. Not sure if that's healthy or helpful.

@thejdizzler I remember you mentioned a while back coming into a good bit of money. Did you end up buying property or otherwise improving your life with it?

It's sitting in my Fidelity account still as a combination of index funds, CDs, and cash. I'm going to buy a house with it once I get a job post PhD.

Spending last month was only 2.6k, which led me to have an almost 30% savings rate!

Congratulations on that. I wonder if there's enough interest in personal finance, investing, and what-have-you for a "Money Monday" thread.

I'd be interested!

Why not just this one? Financial wellness is real wellness.

Shareholder Saturday? Or Speculator.

The choice of day should perhaps be strategic. The weekend is a great time for screening for stocks to buy at the start of the next week.

day of the true Sabbath seems like the only fitting one if Mammon is who we wish to invoke. Hava Nagila every Saturday it should be

Had to look up a bunch of religious lore to understand your joke. At least I think it's a joke and not a dogwhistle. :) Yes, let's worship money on the Sabbath!

That's a good point.

Be the change you want to see in the world. I'll be watching it with interest (pun completely unintended, I only noticed it after the fact).

"Fiscal Friday" has a better ring to it than "Money Monday" though, IMO.

Friday's already taken sadly.

Is there a rule saying we can't have two different threads on the same day?

I mean, there aren't that many threads which get posted. I think it's ok to have more than one weekly thread on a given day.

  • My upper back and shoulders felt stiff from Tuesday onwards last week, so I didn't feel up to going to the gym. Ended up having to do all three sessions back to back on Friday-Sunday. The most frustrating thing is that I was doing deadlifts on Saturday and felt absolutely fine during and afterwards, but when I woke up on Sunday morning I could feel that I'd aggravated my dodgy disc, yet again. I have no idea what I'm doing wrong, I genuinely thought I'd perfected my deadlift form. A quick Google suggests that I need to improve my core strength, so I'm planning to go to the gym this evening and do some core exercises (plank etc.). Any advice for strengthening my core would be greatly appreciated. Can deadlift 1.84x my bodyweight for 3 reps, squat 1.15x for 7 reps and bench press .87x for 6 reps.
  • Have not consumed any pornography since waking up on January 1st.
  • Planning to post my eleventh blog post of the year either today or tomorrow morning.

I watched a video that said that core exercise advice is really bad since there's no progression or anything for most of them. What you want is progressive overload, just like any other muscle group. Try cable crunches.

I stopped doing core at all once I started doing compounds above body weight. I think the compound itself does all the core you need.

At 1.8x deadlift, stuff like planks is just way too easy for your core now. You will need to do hanging leg raises or something.

I found a list of core exercises online. Last night I went to the gym and began working my way through them, looking for ones I particularly enjoyed. These included:

  • Dragon flag
  • Russian twist
  • Medicine ball slam (tremendous fun, that)
  • Kneeling landmine rotation

among some others that I didn't enjoy as much/seemed too easy.

Though the discomfort hasn't entirely subsided, my lower back felt a bit better today, although it might be coincidence. I think I'll need to ask one of the trainers in the gym to inspect my deadlift form and tell me what I'm doing wrong.

I'll give myself a pass mark, not because I physically went to the gym (I didn't), but because I've been doing non-zero amounts of exercise at home and bought a set of dumbbells (which I did use! I'm not using the mere act of purchase as an excuse).

The next few weeks are going to be hectic. I've got an important exam coming up, and while that's not entire incompatible with working out regularly, it makes it hard.

Keep the dumbbells by your computer. Work in a few reps when you pause to think or switch tracks.

Spending is $990.72 higher than it was at the same time last year. Almost all of this difference is due to the dental bills and home repair/maintenance bills that I've racked up this year.

I do have some additional non-standard spending on top of that:

  • I prepaid for my annual pest control bill that keeps my house from getting destroyed by carpenter bees, since the company offers a discount.
  • I took my brother and his girlfriend out for a belated birthday lunch.
  • I went out with my partner and got us some Mexican.

On the bright side, I negotiated a $10/month discount with my ISP. It's not much, but it's not nothing.

It's frustrating that I can't really get ahead compared to last year, but I'm also glad that I've been making the effort. I'd probably be cashflow negative for a few months already if I hadn't made this resolution.

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